Healthcare Provider Details

I. General information

NPI: 1649666009
Provider Name (Legal Business Name): AARON CUNNINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MCCLENNAN BANKS DR
CHARLESTON SC
29425-1614
US

IV. Provider business mailing address

10 MCCLENNAN BANKS DR MSC 918
CHARLESTON SC
29425-1164
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3853
  • Fax:
Mailing address:
  • Phone: 843-792-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD90892
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: